Korean J Pain 2017 October; Vol. 30, No. 4: 287-295 pISSN 2005-9159 eISSN 2093-0569 https://doi.org/10.3344/kjp.2017.30.4.287 | Original Article | State of education regarding ultrasound-guided interventions during pain fellowships in Korea: a survey of recent fellows 1Department of Anesthesiology and Pain Medicine, Presbyterian Hospital, Jeonju, 2Department of Anesthesiology and Pain Medicine, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, 3Department of Anesthesiology and Pain Medicine, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan, 4Mac Pain Clinic, Seoul, 5Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, 6Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, 7Department of Anesthesiology and Pain Medicine, Ajou University Hospital, Suwon, 8Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, 9Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, School of Medicine, Wonkwang University, Wonkwang Institute of Scinece, Iksan, 10Committee on Ultrasound in Pain Medicine, Korean Pain Society, Seoul, Korea Hyung Tae Kim1,10, Sae Young Kim2,10, Gyung Jo Byun3,10, Byung Chul Shin4,10, Jin Young Lee5,10, Eun Joo Choi6,10, Jong Bum Choi7,10, Ji Hee Hong8,10, Seung Won Choi9, and Yeon Dong Kim9,10 Background: Recently, the use of ultrasound (US) techniques in regional anesthesia and pain medicine has increased significantly. However, the current extent of training in the use of US-guided pain management procedures in Korea remains unknown. The purpose of the present study was to assess the current state of US training provided during Korean Pain Society (KPS) pain fellowship programs through the comparative analysis between training hospitals. Methods: We conducted an anonymous survey of 51 pain physicians who had completed KPS fellowships in 2017. Items pertained to current US practices and education, as well as the types of techniques and amount of experience with US-guided pain management procedures. Responses were compared based on the tier of the training hospital. Results: Among the 51 respondents, 14 received training at first- and second-tier hospitals (Group A), while 37 received training at third-tier hospitals (Group B). The mean total duration of pain training during the 1-year fellowship was 7.4 months in Group A and 8.4 months in Group B. Our analysis revealed that 36% and 40% of respondents in Groups A and B received dedicated US training, respectively. Most respondents underwent US training in patient-care settings under the supervision of attending physicians. Cervical root, stellate ganglion, piriformis, and lumbar plexus blocks were more commonly performed by Group B than by Group A (P ＜ 0.05). Conclusions: Instruction regarding US-guided pain management interventions varied among fellowship training hospitals, highlighting the need for the development of educational standards that mandate a minimum number of US-guided nerve blocks or injections during fellowships in interventional pain management. (Korean J Pain 2017; 30: 287-95) Key Words: Education; Fellowship; Injections; Lumbar plexus; Nerve block; Neuronavigation; Pain management; Piriformis muscle; Spinal nerve root; Spine; Training; Ultrasound. Received August 16, 2017. Revised September 17, 2017. Accepted September 19, 2017. Correspondence to: Yeon Dong Kim Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, 895 Muwangro, Iksan 54538, Korea Tel: ＋82-63-859-1562, Fax: ＋82-63-857-5472, E-mail: [email protected] This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright ⓒ The Korean Pain Society, 2017 288 Korean J Pain Vol. 30, No. 4, 2017 INTRODUCTION and consulting patients treated annually. As a result, those with fewer than 3,000 points were classified as first-tier, Recently, the use of ultrasound (US) during pain manage- those with from 3,000 to 6,000 points were considered ment interventions has increased exponentially due to sev- second-tier, and those with more than 6,000 points as eral advantages over other techniques, such as improved third-tier training hospitals. Survey respondents were safety, portability, cost-effectiveness, and reduced ex- categorized into two groups, as follows: Group A, gradu- posure to radiation [1]. ates of programs conducted at first- and second-tier US has proven especially useful for differentiating training hospitals; Group B, graduates of programs con- among acute injury, chronic disease, and normal anatomic ducted at third-tier training hospitals. variations within the musculoskeletal system. Furthermore, The survey consisted of 12 questions regarding current US is non-invasive, and can be used to facilitate the deliv- US practices and education during pain management ery of nerve blocks and soft tissue injections. Despite such fellowships. Respondents of each group were asked to pro- advantages, US-based interventions are limited by the skill vide information regarding the type and duration of train- of the operator, which is dependent on proper instruction ing in pain management procedures, as well as the pres- and sufficient practice/experience. Consequently, recent ence of US equipment in each pain clinic, methods of US research has focused on the development of specific edu- training, techniques, and their overall experience in per- cational curricula for specialties in which US is frequently forming US-guided procedures in pain management settings. utilized. While a few such studies have focused on the field Additional questions regarding fluoroscopy-guided in- of pain management [2,3], no reports have discussed the jections were included within the original questions to ob- application of such curricula in Korea. tain further information. The rate of US utilization and Therefore, the present study aimed to assess the cur- types of procedures performed in clinical practice for each rent state of US training in fellowship programs of the body part, which was classified based on bodily regions Korean Pain Society (KPS) through comparative analysis were as follows: cranial, cervical, thoracic, lumbar, or between training hospitals. sympathetic/peripheral injection were compared between the two groups. The survey contents are referenced in MATERIALS AND METHODS Appendix 1. Statistical analyses were performed using SPSS ver- In February of 2017, we conducted an anonymous survey sion 17 (SPSS Inc., Chicago, IL, USA). Mean differences of 51 pain physicians who had completed a KPS fellowship were analyzed using independent Samples t-tests and de- program. The duration of most fellowship programs was scriptive statistics. Descriptive data are expressed as fre- 12 months (11.64 ± 0.77 m). The questionnaire was devel- quencies and percentages. Categorical data were analyzed oped in conjunction with recommendations provided by using chi-square tests. The level of statistical significance members of the KPS Committee on US in Pain Medicine. was set at P ＜ 0.05. The training hospitals at which KPS fellowships were com- pleted were classified as first-, second-, and third-tier RESULTS hospitals. This was based on the number of points, which were the sum of the number for outpatients, inpatients, In 2017, there were 55 training hospitals with KPS pain Ta b le 1 . Characteristics of Respondents Numbers of hospital classified by KPS Number of fellows responded in this study (n = 55, year of 2017) (n = 51) 1st-tier training hospital 2 3 2nd-tier training hospital 17 11 Group A (n = 14) 3rd-tier training hospital 36 37 Group B (n = 37) KPS: The Korean Pain Society. www.epain.org Kim, et al / Ultrasound in Korean pain fellowships 289 management fellowships: 2 in first-tier hospitals, 17 in 21.4% (n = 3) and 37.8% (n = 10) of respondents performed second-tier hospitals, and 36 in third-tier hospitals. The only work associated with pain management via a pain number of respondents from the included participants were clinic, respectively. Other participants had undergone 3 in first-tier hospitals, 11 in second-tier hospitals, and combined training in anesthesia and pain medicine, or had 37 in third-tier hospitals (Table 1). completed rotations focused on several areas of pain med- The types of work performed during each pain man- icine (Fig. 1). All respondents reported that US equipment agement fellowship were as follows: In Groups A and B, had been available in their respective pain clinics, with the exception of one respondent in Group B. The duration of pain management training during the fellowship program varied from 5 months to 12 months in both groups (Table 2). In Group A, dedicated US training was provided for 36% (n = 5) of respondents, ranging from 1-3 months in 14% (n = 2) of respondents. In Group B, dedicated US training was provided for 40% (n = 15) of re- spondents, ranging from 1-3 months in 19% (n = 7) and ＞ 3 months in 16% (n = 6) of respondents (Fig. 2). Although training methods varied, no significant dif- ferences were observed between the two groups based un- der the supervision of experienced clinicians (P = 0.150), by the journal or textbook (P = 0.202), and phantom or model-based training (P = 0.080). Additional training methods included cadaver-based training, online assess- Fig. 1. Types of work during pain fellowships. Number of ments, and educational workshops conducted by the KPS respondents are expressed in each group. (Fig. 3). Fig. 2. Dedicated training duration regarding ultrasound-guided procedures. Ta b le 2 . Duration of Pain Management Training during Pain Fellowships 5 m 6 m 7 m 8 m 10 m 12 m Group A (n = 14) 0 10 0 1 0 3 Group B (n = 37) 1 19 1 1 1 14 Total (n = 51) 1 29 1 2 1 17 (1.0%) (56.8%) (1.0%) (3.9%) (1,0%) (33.3%) www.epain.org 290 Korean J Pain Vol.